Degenerative Lumbar Canal Stenosis Research Articles

Correlation of Tumor Necrosis Factor-α Expression with Pain Level in Degenerative Lumbar Canal Stenosis Patients

Introduction: Pain in degenerative lumbar canal stenosis is caused by osteoarthritis of a facet joint and intervertebral disc degeneration. Some inflammatory mediators such as tumor necrosis factor (TNF)-α are present in degenerative lumbar canal stenosis. This study aimed to evaluate the correlation of pain and functional pre-operative scores with the expression of TNF-α in nucleus pulposus, annulus fibrosus, and facet joint. Methods: Patients diagnosed with degenerative lumbar canal stenosis and planned for surgical treatment were included in this study. Patients with history of fracture, neoplasm, and/or infection of the spine were excluded. Tissue samples were collected from the nucleus pulposus, annulus fibrosus, facet joint, flavum ligament and paraspinal muscles of the spine during the surgery. TNF-α expression was examined semi-quantitively and correlated with the axial and radicular pain that were measured using Visual Analog Score (VAS) score. The result was then statistically analyzed. Results: The expression of TNF-α in the paraspinal muscle (6.30±14.20) was significantly higher compared to other locations. TNF-α expression in the facet joint group was significantly correlated with the intensity of low back pain measured by VAS score (r=0.893, p < 0.001), and pre-operative functional outcome based on Oswestry Disability Index (ODI) (r=0.948, p < 0.001). Conclusion: TNF-α expression, especially in the facet joint, is significantly associated with the pain intensity and pre-operative ODI that allow pain reduction with less invasive treatment in lumbar canal stenosis patients.

Results of posterior decompression with non-instrumented lumbar fusion surgery in cases of degenerative lumbar canal stenosis presenting with neurogenic claudication in a tertiary care hospital

<p><strong>Background:</strong> Degenerative lumbar canal stenosis remains an important public health problem in today’s date. With the overall average age of the world’s population rising steadily it is important to have an optimal treatment plan affordable to the masses. Non-instrumented fusion after decompression remains an important treatment option which is affordable to the masses and effectively treats the instability occurring due to degeneration process. This study aims to understand the results of such treatment in a tertiary care center catering to the masses.</p><p><strong>Methods: </strong>The study was conducted in 34 patients with diagnosed degenerative lumbar canal stenosis with neurogenic claudication who underwent decompressive laminectomy with a posterolateral strut graft posterolateral fusion from July 2018 to August 2020. Each patient was followed up for 12 months.</p><p><strong>Results: </strong>In the present study, a total of 34 patients with degenerative lumbar canal stenosis with neurogenic claudication were included. There were 18 male and 16 female patients. The pre-operative Swiss spinal stenosis Score was 61-80 (52.9%) and these scores improved to a majority of patients in the category of 21-40 (82.4%) at 1 year postoperatively. The average VAS score was 4.7±1.8 preoperatively while the average post op VAS score was 0.8±0.77.</p><p><strong>Conclusions: </strong>Non-instrumented fusion of the vertebrae with decompression has significantly improved results at 1 year follow up postoperatively and it is an excellent easy and cost-effective technique if used in a properly selected patient. Further studies are required to assess its long-term results.</p>

Unilateral Biportal Endoscopy Versus Tubular Microendoscopy in Management of Single Level Degenerative Lumbar Canal Stenosis: A Prospective Study.

Prospective clinical study. To the authors knowledge, there are no previous prospective studies to test the feasibility of the unilateral biportal endoscopic (UBE) technique in management of lumbar canal stenosis. The study was conducted to compare clinical results of the UBE technique with the tubular microendoscopic (TME) surgery for management of degenerative lumbar canal stenosis. One hundred fifty-four cases of single level degenerative lumbar canal stenosis were randomly divided into 2 groups. Each group consisted of 77 cases: one group underwent UBE and the other TME. Clinical outcome was assessed periodically: early postoperative, at 1, 3, and every 6 months for 2 years. Clinical outcome assessment operatives included the Oswestry Disability Index (ODI), Zurich Claudication Questionnaire (ZCQ), and patient satisfaction using Modified Macnab Criteria (MMC). In addition, the admission period, operative time, and estimated blood loss were compared. In UBE cases, ODI and ZCQ were statistically superior to TME for all periods (P<0.05). For both approaches, values presented progressive improvement until the 24th month. Regarding ODI, UBE and TME had an 84% and 79% success rate, respectively. In ZCQ, UBE and TME had a 79% and 73% success rate, respectively, at the end of the 24th month. Regarding the MMC, UBE and TME had 63% and 29% excellent results, respectively. UBE also has shorter admission period (days: 1.11 vs. 1.28), operative time (minutes: 57.74 vs. 65.31), and less estimated blood loss (mL: 49.47 vs. 53.57). Given its demanding learning curve, UBE is considered an effective alternative to TME with a higher clinical success rate.

Evaluation of posterior decompressive lumbar surgery for multilevel lumbar spinal canal stenosis with and without fusion

BackgroundThere is no consensus regarding the best treatment of patients with multilevel lumbar stenosis. Surgical and invasive procedures are widely used in adults with degenerative lumbar spinal stenosis when conservative treatments fail. However, little is known about the comparative efficacy and safety of these interventions.Aim and objectiveThe aim was to study and evaluate the outcome of surgery for degenerative lumbar canal stenosis (LCS) on a clinical, radiological, and functional basis and to identify whether spinal decompression with fusion has a better effect than decompression alone for patients with degenerative lumbar spinal stenosis or not.Patients and methodsA prospective study of 50 patients was carried out at the Department of Neurosurgery, Matarya Teaching Hospital, in whom the lumbar canal stenosis was confirmed. The functional assessment preoperatively and postoperatively was calculated according to the Japanese Orthopedic Association (JOA) score.ResultsSuccessful outcomes were significantly associated with posterior decompression and fusion. Clinical outcome assessed according to the JOA score was excellent or good in 68% of the patients who underwent posterior decompression alone and in 84% of patients who underwent posterior decompression with posterolateral fusion.ConclusionSurgical treatment of degenerative lumbar canal stenosis with posterior decompression and spinal fusion yields excellent results as observed on the basis of JOA scoring system.

Unilateral Fenestration versus Open Laminectomy in Treatment of Degenerative Stenosis of Lumbar Spine

Background: The syndrome of degenerative lumbar canal stenosis accounts for a large percentage of causes of low back pain in the elderly worldwide. Surgical management has demonstrated better clinical and radiological results than conservative treatment. It allows for adequate decompression of the thecal sac and the compressed nerve roots. However, aggressive laminectomy with facetectomy has been linked with many postoperative complications including instability. Hence, new less invasive modalities have been introduced such as fenestration and endoscopic laminotomy. Objective: This study aimed at comparing the safety and outcome of conventional laminectomy to unilateral fenestration in cases of lumbar canal stenosis. Patients and methods: It took place at the Neurosurgery Department at Zagazig University and included thirty six patients with lumbar canal stenosis; eighteen patients were treated by conventional laminectomy and eighteen patients were treated by unilateral fenestration. Results: Decompression led to an intense decrease of total pain in both groups. Matched with that experience in group I, but, with more remaining back and leg pain was found in group II, 6.58±0.99 and 6.75±0.96, respectively, compared with 2.16±0.57 and 2.75±0.86 , respectively, at the 12 weeks follow-up assessment (p < 0.001). The most obvious symptom of lumbar stenosis, neurogenic claudication improved in 91% of patients in group I compared to 83% in Group II. Patient satisfaction was higher in Group I, as the patients who underwent unilateral fenestration showed more decrease in total pain with 12 weeks postoperatively. Conclusion: Unilateral fenestration allows acceptable and safe decompression of the spinal canal in patients with degenerative lumbar stenosis.

Unilateral Fenestration versus Open Laminectomy in Treatment of Degenerative Stenosis of Lumbar Spine

Background: The syndrome of degenerative lumbar canal stenosis accounts for a large percentage of causes of low back pain in the elderly worldwide. Surgical management has demonstrated better clinical and radiological results than conservative treatment. It allows for adequate decompression of the thecal sac and the compressed nerve roots. However, aggressive laminectomy with facetectomy has been linked with many postoperative complications including instability. Hence, new less invasive modalities have been introduced such as fenestration and endoscopic laminotomy. Objective: This study aimed at comparing the safety and outcome of conventional laminectomy to unilateral fenestration in cases of lumbar canal stenosis. Patients and methods: It took place at the Neurosurgery Department at Zagazig University and included thirty six patients with lumbar canal stenosis; eighteen patients were treated by conventional laminectomy and eighteen patients were treated by unilateral fenestration. Results: Decompression led to an intense decrease of total pain in both groups. Matched with that experience in group I, but, with more remaining back and leg pain was found in group II, 6.58±0.99 and 6.75±0.96, respectively, compared with 2.16±0.57 and 2.75±0.86 , respectively, at the 12 weeks follow-up assessment (p < 0.001). The most obvious symptom of lumbar stenosis, neurogenic claudication improved in 91% of patients in group I compared to 83% in Group II. Patient satisfaction was higher in Group I, as the patients who underwent unilateral fenestration showed more decrease in total pain with 12 weeks postoperatively. Conclusion: Unilateral fenestration allows acceptable and safe decompression of the spinal canal in patients with degenerative lumbar stenosis.

A prospective study analyzing the clinical outcome of degenerative lumbar canal stenosis treated by laminectomy

A prospective study analyzing the clinical outcome of degenerative lumbar canal stenosis treated by laminectomy

Study of Patients with Bilateral Knee Osteoarthritis Undergoing Total Knee Replacement Procedure with Coexisting Lumbar Spondylosis Symptoms.

Study DesignThis is a prospective cohort study involving patients who were followed for 2 years after total knee replacement (TKR) to determine changes in lumbar spine and knee symptoms.PurposeThe objectives of this study were to determine the percentage of patients undergoing bilateral TKR who present with coexisting lumbar spine problems and determine if TKR relieves lumbar spine symptoms.Overview of LiteratureNo studies quantify the percentage of TKR patients who experience relief of lumbar spine symptoms after TKR surgery.MethodsThe study included 200 patients (164 females, 36 males) undergoing primary TKR. Follow-up was performed at 4 weeks, 3, 6, 12, and 24 months. Lumbar spine and knee symptom improvements were assessed using the Oswestry Disability Index (ODI) and Oxford Knee Score, respectively.ResultsAll 200 patients undergoing bilateral TKR presented with radiographic lumbar spine degenerative pathology; 60% (n=120) of the patients presented with moderate to severe clinical symptoms of lumbar spondylosis, including 54% (n=108) with degenerative lumbar spondylosis and lumbar canal stenosis and 6% (n=12) with degenerative spondylolisthesis. Of the 120 patients who presented with lumbar spine problems, 90% (n=108) reported improvement in their symptoms; the ODI score improved from 42.5%±4.1% preoperative score to 15.6%±2.3% postoperative score (p-value<0.001). Of the 12 patients with no improvement, 10 patients underwent percutaneous procedures for their lumbar spine pathology with good results, one patient underwent surgery, and one declined any intervention.ConclusionsA significant number of patients (60%) undergoing bilateral TKR also present with symptomatic lumbar spine problems. Patients with mild to moderate lumbar spine degenerative symptoms and no associated severe radiating pain on activity are more likely to experience relief of their symptoms post-TKR.

Does surgical decompression alleviate neglected cauda equina syndromes attributed to lumbar disc herniation and/or degenerative canal stenosis?

Background: Most studies recommend urgent decompression (e.g., within 48–72 h) of the symptomatic onset of a cauda equina syndrome. As patients in our area typically underwent >3 months delayed surgery for cauda equina syndromes due to disc disease/stenosis, we asked whether surgery was still worthwhile.Methods: This was a retrospective analysis of 12 patients (2012–2018) who underwent delayed surgical decompression for cauda equina syndromes secondary to lumbar disc herniations and/or degenerative lumbar canal stenosis.Results: After a mean postoperative duration of 8.22 months, nine patients experienced the complete restoration of bladder status; two patients required intermittent self-catheterization, while one patient had some residual symptoms (e.g., urgency but able to void with some difficulty).Conclusion: For 12 patients who originally presented with cauda equina syndrome with complete incontinence, nine exhibited delayed full recovery of bladder function with average of 8.22 months postoperatively. We would, therefore, advise that delayed surgical decompression be offered to these patients, irrespective of the preoperative duration of cauda equina syndromes with complete incontinence.

Surgical Treatment of Lumbar Spinal Canal Stenosis by Laminectomy and Posterolateral Fusion

Background: Lumbar spinal stenosis is a common spinal disease, which lead to neural compression leading to pain, limitation of individuals function and reduced the quality of life. Aim of the work:To evaluate the results of surgical treatment of lumbar spinal canal stenosis [LCS] by laminectomy and instrumented posterolateral Fusion. Patients and Methods: A prospective study had been conducted at Orthopedic Surgery Department [Al-Azhar University Hospital, Damietta] to evaluate the outcomes of treatment of lumbar canal stenosis by laminectomy and posterolateral fusion. This study included 15 patients, and the average follow up was 6 months from December 2018 to May 2019. Pain, clinical and radiological outcomes had been assessed. Preoperatively, all patients had been evaluated clinical and radiologically. In addition, lab investigations had been performed to assess the patient. Results: The study included 15 patients [10 females and 5 males], their age ranged between 30-55 years [mean age 42.8 years]. The surgical outcome [according to Odom Criteria] revealed that, excellent outcome reported among 26.7%, and 40% had good outcome, fair outcome among 26.7% and poor outcome among 6.7%. Conclusion: Laminectomy with instrumented posterolateral fusion is a good surgery to treat degenerative lumbar canal stenosis, with reasonable outcome.

Comparative Study of Minimally Invasive Lumbar Decompression versus Decompressive Laminectomy with Posterolateral Transpedicular Fixation for the Treatment of Degenerative Lumbar Canal Stenosis.

Background:The classic laminectomy for spinal decompression was the treatment of choice of the degenerative lumbar canal stenosis (LCS). Many surgeons prefer to add instrumented lumbar fusion to avoid future instability after the removal of posterior elements. Adding fusion is associated with more bleeding and longer periods of hospitalization. Minimally invasive lumbar decompression (MILD) has been advocated for successful decompression with less bleeding loss and shorter hospitalization.Aim of the Work:To evaluate and compare the clinical outcomes of two different treatment modalities for degenerative LCS: the classic laminectomy with posterolateral transpedicular screw fixation and the MILD.Patients and Methods:Fifty patients with degenerative LCS were randomized from two institutions: Ain Shams University Hospital and Arab Contractors Medical Center, who underwent surgeries for degenerative LCS between 2016 and 2018 with 1-year follow-up. The study compared two cohorts: Group A – 25 patients underwent classic lumbar laminectomy with posterolateral transpedicular fixation, and Group B – 25 patients underwent MILD.Results:There were no statistically significant differences between both treatment modalities in the VAS for leg pain and back pain, the patient satisfaction index, and the Oswestry disability index after 1 year. The fusion operations were associated with higher estimates of blood loss, longer hospital stay, and more financial costs.Conclusion:MILD has the same satisfactory results as classic laminectomy with posterolateral fixation for the treatment of degenerative LCS with less bleeding loss and shorter hospitalization. Since the results are comparable, MILD is suggested in low-income countries as Egypt for economic reasons.

Unilateral biportal endoscopic decompression for degenerative lumbar canal stenosis.

Unilateral biportal endoscopic (UBE) decompression is a minimally invasive (MI) approach to treat degenerative lumbar canal stenosis (DLCS). Decompression can be performed in a clear and magnified surgical field with proper control of normal saline inflow and outflow. Clinical and radiographic data of 81 consecutive patients of DLCS treated between July 2018 and Feb 2019 using UBE techniques were reviewed. They were 38 males and 43 females with an average age of 70.2. Sixty-nine had pure canal stenosis and 12 patients had associated spondylolisthesis. Bilateral decompression via unilateral laminotomy was performed from the side on patients with more severe neurological symptoms. This is a retrospective study from chart review and image analysis. Therefore, we don't have formal ethical information for this study, and it is not mandatory in our hospital. At the final follow-up, the mean VAS for low back pain was improved from 4.3±3.0 to 1.2±1.0 and the VAS for leg symptoms was improved from 7.3±2.2 to 0.9±0.7. The mean JOA score and ODI was significantly improved from 13.3±7.9 to 25.3±5.0 and from 54.6±16.9 to 14.6±12.6, respectively. Modified Macnab criteria were excellent in 47 patients (58.0%), good in 29 (35.8%), fair in 5 (6.2%). The average hospital stay was 3.6±2.4 days. MRI before and after the operation showed the cross-sectional dural area (CSDA) was significantly increased from 71.4±36.5 to 177.3±59.2 mm2, corresponding to a 201.9%±188.0% increase. The percentage of facet joint preservation was 84.2% on the approach side and 92.9% on the contralateral side. Complications included 4 dural tears, 1 transient motor weakness, 1 inadequate decompression, and 1 epidural hematoma. With UBE techniques, decompression for DLCS can be performed safely and effectively. The soft tissue and facet joint destruction are minimized; therefore, it is possible to avoid spinal fusion as well as to preserve the segmental stability.

Morphological Changes in the Ligamentum Flavum in Degenerative Lumbar Canal Stenosis: A Prospective, Comparative Study.

Study DesignProspective, comparative.PurposeTo compare the histopathological and electron microscopic changes in the ligamentum flavum (LF) between degenerative lumbar canal stenosis (LCS) and lumbar disk herniation (LDH).Overview of LiteratureThe LF has been implicated as a key structure in the pathogenesis of LCS. With aging, the LF undergoes morphological changes–a decrease in the elastic component and an increase in the collagen component, in addition to other focal changes. By comparing the histopathological and electron microscopic picture of the LF in elderly patients with LCS with that in young patients with LDH, the role of this ligament in the pathogenesis of LCS may be clarified.MethodsForty patients were prospectively recruited and divided into two groups: group 1 included 20 patients with degenerative LCS aged >55 years and group 2 included patients with LDH aged <35 years. The ligament flava were collected during the patients’ surgery. The features noted on histopathological examination included the fibrosis score, the loss of elastic fibers, calcification, chondroid metaplasia, mucinous degeneration, vascularization, long septa, clefts, granulation tissue, and ganglion-like cysts. The features noted on electron microscopic examination included the elastic fiber thickness, the quality of elastic fibers, the elastic:collagen ratio, calcification, melanin fibers, remnants of necrotic cells, and electron-dense material in the LF. All parameters were compared between group 1 and group 2.ResultsOn histopathological examination, the two groups exhibited significant differences regarding three parameters: chondroid metaplasia, long septa, and ganglion-like cysts. On electron microscopy examination, significant differences were observed between the two groups regarding two parameters: the quality of elastic fibers and the elastic:collagen ratio.ConclusionsCharacteristic morphological changes may be noted on histopathological and electron microscopic examination that mark the degenerative changes in the LF that contribute to the occurrence and pathogenesis of degenerative LCS.

The Role of JAK-STAT Signaling Activation in Hypertrophied Ligamentum Flavum

Although previous studies have reported the expression of JAK1, STAT3, and phosphorylated STAT3 in hypertrophied ligamentum flavum (LF), the role of the Janus kinase-signal transducer and activator of transcription (JAK/STAT) signaling pathway in hypertrophied LF has not been fully elucidated. The aim of this study was to identify the important JAK/STAT gene expression patterns of the 3 main receptors involved in this pathway: interferon (IFN)-γ receptor (IFN-γR), IFN-α receptor (IFNAR), and interleukin (IL)-6 receptor (IL-6R). The human LF specimens were obtained from 28 patients who underwent lumbar spine surgery for either degenerative lumbar canal stenosis (DLCS) (n= 28) or lumbar disc herniation (LDH) (n= 20). In this design, patients with LDH served as the control group. The degree of fibrosis was demonstrated by Masson's trichrome staining. The location and expression profiling of the JAK/STAT pathway were analyzed by quantitative real-time polymerase chain reaction and Western blotting. The thickness of the LF was measured with axial T1-weighted magnetic resonance imaging. The most severe fibrotic changes were on the dorsal side of the LF. IL-6 and IFN-I expression levels were significantly increased on the dorsal side of the LF. While expression levels of IL-6R and IFNAR on the dural and dorsal side were significantly higher in the DLCS samples, IFN-γR and endothelial epidermal growth factor receptor in LF samples showed a significant increase only on the dorsal side. JAK/STAT genes were significantly expressed, especially on the dorsal side. Our data suggest that IFNAR- and IL-6R-dependent JAK/STAT signaling pathways may be significant targets in drug development strategies for the treatment of LF hypertrophy.

Learning curve of tubular micro-endoscopic decompression in patients with degenerative lumbar canal stenosis over 200 cases

Introduction: Tubular micro-endoscopic decompression is a technically demanding surgical technique involving familiarity of microscope handling with surgical and radiographic anatomical planning. Understanding the learning curve is necessary to delineate the problems faced during initial cases to reduce the complication rates and set guidelines for safe spine surgery through educational and training programs on bone-saw models and organizing workshops to enhance the standard of health care with improvement in surgical skills. Aims and Objectives: The aim of this study was to evaluate the learning curve of tubular micro-endoscopic decompression in patients with degenerative lumbar canal stenosis based on surgical and clinical parameters and delineate the challenges faced in early cases in long series of patients. Materials and Methods: Study design. Retrospective analysis of prospectively collected data. Study cohort. Data of first 220 consecutive patients with single-level degenerative lumbar canal stenosis managed with tubular micro-endoscopic decompression surgery from 2010 to 2016 with a minimum two-year follow-up were retrieved. Methodology. First 200 patients available at the final follow-up were divided into quartiles (50 each) as per the date of surgery with each consecutive group serving control for prior. Preoperatively and postoperatively clinical parameters (pain scores: visual analog scale [VAS]; functional disability: oswestry disability index [ODI] score), perioperative (operative time, blood loss, and hospital stay), technical issues (guide wire migration, tube docking-related problems, and dural tear), and postoperative complications (postoperative leg pain, neural injury, infection, and recurrence) were evaluated. Statistical analysis. The logarithmic curve-fit regression analysis and analysis of variance test were used to find the asymptote. Results: The mean age of patients was 61.81 years (ranging from 39 to 85) with male-to-female ratio of 121:79 with no significant difference among the quartiles. Statistically significant differences (P < 0.005) were noted in mean operative time (q1 = 109 min, q2 = 69.4 min) and mean blood loss (q1 = 110.6 mL, q2 = 69.6 mL) between the first and second quartiles with no further significant reduction in the third and fourth quartiles.Statistically significant differences (P < 0.005) in clinical parameters (VAS preoperative/postoperative 6.7/1.43; ODI preoperative/postoperative 39.08/12.63) were noted but were not associated with surgical experience. Hospital stay time did not show any significant difference among the quartiles.Guide wire-migrated issues, neural injury, dural tear, and tube docking-related problems significantly reduced after q1. However, recurrence occurred at any phase. Infection occurred in one patient in the first quartile.Although blood loss and operative time showed a declining trend, it was not significant after the second quartile. Therefore, asymptote lay in the first quartile; however, we recommend that novice surgeon should perform 50–100 cases to achieve mastery in this technique as different surgeons have different learning abilities. Conclusion: For mastering the art of tubular micro-endoscopic decompression for lumbar canal stenosis and to reduce its learning curve, novice surgeons can avoid the challenges and problems faced during initial cases with improvement in surgical skills by doing practice on cadavers and bone-saw models following certain recommendations that we came through our learning curve of surgical experience so that the results of their initial surgery are similar to the results that we had after achieving asymptote. Familiarity with instrumentation, communication between surgical team, and defined expectations from radiology technician are the keys to reduce the learning curve.

Outcomes of lumbar canal stenosis treated with posterior decompression and spinal instrumentation

Outcomes of lumbar canal stenosis treated with posterior decompression and spinal instrumentation - IJOS- Print ISSN No: - 2395-1354 Online ISSN No:- 2395-1362 Article DOI No:- 10.18231/j.ijos.2019.005, Indian Journal of Orthopaedics Surgery-Indian J Orthop Surg

Spinal decompression and instrumented fusion in an elderly woman: A case report and literature review

The increase in population of older adults will be associated with a parallel increase in musculoskeletal problems such as arthritis and spinal problems. Surgical treatment of degenerative disease of the spine can produce significant improvements in function in suitably selected patients. Improvements in surgical and anesthetic techniques may make more-invasive surgery feasible for elderly patients. We present a case of an 89-year-old woman, who presented with lumbar radiculopathy due to degenerative lumbar canal stenosis and multilevel instability. She was managed successfully with spinal decompression and instrumented spinal fusion of L4/5 and L5/S1 segments.

Vitamin D Deficiency: A Cause of Secondary Lumbar Canal Stenosis - A Case Report

Background: Degenerative lumbar canal stenosis presents with low backache. Ligamentum flavum hypertrophy secondary to vitamin D deficiency causes central canal stenosis. This is a common presentation in obese females residing in North India. Case presentation: We present the case of a young, obese, north Indian 32-year-old female, who had a history of chronic low mild backache, with reduced spine mobility, with MRI lumbosacral scan revealing grade I spondylolisthesis with spondylolysis seen at L4 over L5 and ligamentum flavum and facetal hypertrophy. Further workup showed raised serum parathormone (PTH) and deficient serum 25-OH Vitamin D total levels. Hypovitaminosis D was responsible for the ligamentum flavum hypertrophy and secondary lumbar canal stenosis. She was discharged on Vitamin D replenishment regimen. Conclusions: Vitamin D deficiency is coexistent with low backache, secondary to degenerative lumbar canal stenosis.

Evaluation of wide interlaminar fenestration surgery in degenerative lumbar canal stenosis

Background: With the increasing longevity of population and a continually climbing proportion of middle-aged and elderly persons, the problem of lumbosacral spine is a significant health care issue, causing backache and Neurogenic claudication. Methods: Thirty patients with degenerative lumbar canal stenosis were included in study and wide interlaminar fenestration with or without discectomy was carried out. Patients were followed and analysis of the outcome was done for improvement in pain, neurological improvement and improvement in claudication distance. Results: Diagnosis of degenerative lumbar canal stenosis were made by clinical examination and confirmed by measuring neural canal diameter in MRI. Patients were selected randomly and total 30 patients included in study with mean age of 45.9 year and with mean duration of symptom was 38.67 months. Wide interlaminar fenestration was done at two level (L4-5, L5-S1) in 9 patients and at one level in remaining 21 patients (L4-L5 in 12 and L5-S1 in 9).All the patients improved in terms of back pain, sensory and motor symptoms including neurogenic claudication. Conclusion: At the end of our study we find that Wide Interlaminar fenestration done in degenerative lumbar canal stenosis provides not only full resolution of neurological symptom but also maintains spinal stability at the same time.

Assessment of Clinical Outcome of Bilateral Decompression through Unilateral Approach in Lumbar Canal Stenosis

Background Data: Acquired degenerative lumbar canal stenosis is considered a common indication for lumbar spine surgery in old patients. The traditional approach is wide open laminectomy, medial facetectomy, and foraminotomy, which includes bilateral muscle separation and extensive excision of the posterior spinal structures. Minimal invasive surgeries as microsurgical and endoscopic have been now used for the treatment of lumbar canal stenosis during the last years.Purpose: To assess clinical outcome of unilateral approach in bilateral decompression of lumbar canal stenosis.Study Design: Observational analytic prospective study.Patients and Methods: Twenty patients with degenerative lumbar canal stenosis have undergone bilateral decompression from unilateral approach at Ain Shams university hospitals between May 2014 and April 2016. Prospective analysis of their clinical outcome was conducted.Results: In this study twelve were male (60%) and eight were female (40%). The mean age was 43.1±12.33 (range 35-55years). The duration of clinical presentation ranged from 6 to 24 months. Preoperative clinical presentation was low back pain (95%), sciatica (85%), neurogenic claudication (100%) and sensory changes (80%). Marked improvement of preoperative leg pain has been observed after surgical decompression. Significant reduction of the mean preoperative VAS (7±0.72) (over all back and leg pain) to VAS 2±0.72) at one, (1.85± 0.58) at three and (1.6± 0.68) at 6 months (P>0.001). The mean ODI scores decreased significantly at one (27±9.78), three (23±7.3) and six months (21±4.47) from the mean preoperative ODI score (61±4.47) (P>0.0001). Accidental durotomy was reported in one patient (5%) and it was in the posterior dura under the opposite lamina just off the midline.Conclusion: Unilateral approach in bilateral decompression is an effective procedure for management of lumbar canal stenosis. (2016ESJ119)